Annals for Educators - June 2022
Authors: Christine Laine
Journal: Annals of Internal Medicine (2022)

Web ExclusivesJune 2022Annals for Educators - June 2022FREEChristine Laine, MD, MPHChristine Laine, MD, MPHSearch for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/AWED202206210 SectionsAboutVisual AbstractPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Clinical Practice PointsDiabetes Screening by Race and Ethnicity in the United States: Equivalent Body Mass Index and Age ThresholdsDiabetes Screening: Different Thresholds for Different Racial/Ethnic GroupsIn this study, the authors used NHANES (National Health and Nutrition Examination Survey) data to determine body mass index (BMI) and age thresholds for diabetes screening among U.S. racial and ethnic minority populations that would produce benefits and harms equivalent to those of the current thresholds for White adults. They found that persons in underrepresented racial and ethnic groups have higher prevalence rates of diabetes at a lower BMI and younger age than White persons. The accompanying editorial proposes that the U.S. Preventive Services Task Force consider race and ethnicity in diabetes screening recommendations as it does for other conditions.Use this article and the editorial to:Review the diabetes screening guidelines from the U.S. Preventive Services Task Force.Discuss the concept of race as a social construct rather than a biological construct.Discuss how NHANES defines race, and ask your learners whether race should be a standard part of such U.S. population studies.Ask your learners to identify potential benefits and harms of considering race when determining when to screen people for diabetes.Adverse Events Associated With Coprescription of Phosphodiesterase Type 5 Inhibitors and Oral Organic Nitrates in Male Patients With Ischemic Heart Disease. A Case-Crossover StudyUsing oral nitrates and phosphodiesterase type 5 inhibitors together can lead to abnormally low blood pressure, which in turn could cause harms such as syncope, stroke, and acute myocardial infarction. This study examined whether these possible harms occur with everyday use of the drugs.Use this article to:Review how case-crossover studies are conducted. What are the advantages of this somewhat complicated study design compared with a cohort study?Ask your learners if they have ever had a patient who was taking both nitrates and a phosphodiesterase type 5 inhibitor and had a cardiovascular event.Review the package inserts for an oral nitrate and a phosphodiesterase type 5 inhibitor. Does the information in the insert correspond to the findings of this study?Given the findings of this study, ask your learners what guidance they would give to patients when coprescribing an oral nitrate and a phosphodiesterase type 5 inhibitor.Mortality and Morbidity in Mild Primary Hyperparathyroidism: Results From a 10-Year Prospective Randomized Controlled Trial of Parathyroidectomy Versus ObservationNonoperative Management of Mild Primary Hyperparathyroidism: A Reasonable, Evidence-Based OptionParathyroidectomy improves outcomes for patients with primary hyperparathyroidism who have marked elevations in serum calcium. This randomized controlled trial with 10 years of follow-up examined whether parathyroidectomy provides similar benefits for patients with primary hyperparathyroidism who have only modest elevations in calcium levels. The accompanying editorial calls for more trials that question and inform clinical recommendations.Use this article and the editorial to:Review how to diagnose primary hyperparathyroidism.Review nonoperative treatment for mild primary hyperparathyroidism.Invite a surgeon to describe how a parathyroidectomy is done and what the typical postoperative course is like.Discuss the factors to consider when deciding whether surgical or nonoperative treatment is the best option for a particular patient.Public HealthChanges in Health Care Spending, Use, and Clinical Outcomes After Nonfatal Firearm Injuries Among Survivors and Family Members. A Cohort StudyHomicide Deaths Among Adult Cohabitants of Handgun Owners in California, 2004 to 2016. A Cohort StudyFirearm Injury in the United States: Time to Confront It as the Epidemic It Has BecomeThe first article extends our knowledge about the consequences of nonfatal firearm-related injuries in survivors and their family members. The study reported in the second article estimated the association between living with a lawful handgun owner and risk for homicide victimization in a population of more than 17 million California adults. The editorial argues that the United States must confront firearm injury as the epidemic it has become.Use these articles and the editorial to:Ask your learners about their experiences caring for patients who have suffered a nonfatal firearm injury. How do the findings of the first article correspond to what they have observed?Ask your learners whether they routinely ask patients about the presence of firearms in their homes. If not, why not?Discuss strategies for counseling patients about prevention of firearm injury. This In the Clinic article will help guide the discussion. Ask your learners if they think firearm injury is a public health issue in the United States. What are their views of the American College of Physicians' policy recommendations on reducing firearm injury in the United States? Human Papillomavirus Vaccine Impact and Effectiveness Through 12 Years After Vaccine Introduction in the United States, 2003 to 2018Long-Term Effectiveness of Human Papillomavirus Vaccination: Implications for Future Reduction in CancerHuman papillomavirus (HPV) vaccines were introduced in 2006 for females and in 2011 for males. This study used NHANES data through 2018 to estimate the effect of HPV vaccination on sexually experienced females and estimated the effect on HPV prevalence for males and females in the most recent periods with data available. The accompanying editorial discusses actions that will be crucial to ensuring that we do not lose a generation to preventable HPV-associated cancer.Use this article and the editorial to:Review the ACIP recommendations for HPV vaccination. Discuss the concept of “herd immunity” and how this study supports that it is occurring with respect to infection with cancer-associated HPV strains in the United States.Academia and the ProfessionAffirmative Action Bans and Enrollment of Students From Underrepresented Racial and Ethnic Groups in U.S. Public Medical SchoolsBetween 1985 and 2019, eight states enacted laws that banned affirmative action during the selection of applicants into 21 public medical schools. This study examined whether the bans affected enrollment from racial and ethnic groups that are underrepresented in medicine.Use this article to:Discuss whether your state is among those that ban affirmative action.Ask your trainees to reflect on the diversity of their own medical school classes.Why is it important to improve the diversity of medical students and residents? This editorial may help initiate the discussion. Beyond the GuidelinesWould You Recommend a Statin to This Patient for Primary Prevention of Cardiovascular Disease? Grand Rounds Discussion From Beth Israel Deaconess Medical CenterRecent guidelines from the American College of Cardiology/American Heart Association and the U.S. Department of Veterans Affairs proposed an approach to statin use in primary prevention of cardiovascular disease but differ on how to establish the efficacy of statins. In this article, a preventive cardiologist and a general internist discuss their approach to statin use and how they would apply the guidelines to an individual patient.Use this article to:Watch the patient video with your learners, and then ask them whether they would prescribe a statin for this patient.Discuss the advantages and disadvantages of prescribing statins in this clinical situation.If a statin were to be prescribed, which one would they choose?Have your learners test their knowledge by completing the quiz that accompanies the article.Prevention and Initial Management of HIV InfectionAlthough eradication of HIV infection remains an elusive goal, there have been meaningful improvements in our ability to prevent HIV infection and to manage patients who have been infected. For example, new drug combinations have been developed for preexposure prophylaxis (PrEP) to prevent HIV infection and transmission, which means that more emphasis is being placed on prevention. In addition, a new rapid test is available for screening. Moreover, the preferred drug combinations for people newly diagnosed with HIV have changed. This article provides updated information about how clinicians should use these and other changes when managing their patients who are at risk for or newly diagnosed with HIV infection.Use this article to:Discuss the presentation of acute HIV infection—many younger physicians have never seen a case.Ask your learners whether they have any patients who are on PrEP. If not, do they have patients who would be good candidates for it?Review the currently available PrEP regimens. This cost-effectiveness analysis provides a comparison of the costs of older oral regimens versus newer long-acting injectable regimens. Discuss the barriers to PrEP. This Annals Graphic Medicine article may be helpful in initiating the discussion. Review criteria for starting HIV treatment, the regimens that are currently available, and the recommended follow-up for patients taking HIV antiretroviral therapy.Test your learners' knowledge by having them complete the quiz that accompanies the article and then reviewing the correct answers.Do you like reading Annals for Educators? Receive it direct to your inbox. Sign up for the Annals for Educators alert today. Comments0 CommentsSign In to Submit A Comment Author, Article, and Disclosure InformationAffiliations: From the Editors of Annals of Internal Medicine and Education Guest Editor, Gretchen Diemer, MD, FACP, Associate Dean of Graduate Medical Education and Affiliations, Thomas Jefferson University. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics June 2022Volume 175, Issue 6Page: ED6 ePublished: 21 June 2022 Issue Published: June 2022 Copyright & PermissionsCopyright © 2022 by American College of Physicians. 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